Enhancing Active Index Case Testing:
Behavioral Skills Training for HDAs in MACRO Lilongwe

A. Ngambi, L. Phiri, P. Damiano,
A. Elias, P. Mbulaje, C. Udedi
Malawi AIDS Counselling and Resource Organization (MACRO)
Presented at SJOGHCS Research Dissemination Conference, December 2023

Introduction

Active Index case testing (AIT) is a highly effective case-finding strategy, which involves elicitation of information from people living with HIV (PLHIV) about their contacts (sexual partners and biological children) and offering them HIV testing services. Malawi is implementing AIT as part of its national strategic plan to achieve the UNAIDS 95-95-95 goals by 2030 which calls for the identification of 95% of PLHIV, initiating and retaining 95% on antiretroviral therapy (ART) and 95% Viral suppression for ART patients.

Problem Statement

There remain challenges to the implementation of AIT, particularly contact elicitation, Tracing and Testing.

Objectives

  • To increase Contact Elicitation, Tracing and Testing of Index Clients
  • To increase Case identification of HIV Infected clients and linking them to HIV care

Methods

In May 2023, 59 MACRO HDAs received AIT behavioral skills-building training. The training focused on eliciting more untested sexual contacts and biological children from indexes through active referral, home visit approach and contact testing. Pre and post-test Knowledge assessment was done through written exams. AIT performance data was compared two months before (March and April 2021) and two months (June and July 2021) after the Training. Data analysis was performed in STATA 17.0 using paired T-test.

Findings

118 written answer sheets were analyzed (59 pre and 59 post).

• Average knowledge increased (P < 0.0001) from 51% to 70%
• Contacts elicitation increased by 19% (3183 to 3779)
• Index to contact ratio increased by 38% (1:2 to 1:3)
• Contacts tested increased by 11% (2999 to 3331)
• New HIV+ contacts increased by 11% (354 to 393)
• Contacts traced increased by 21% (2212 to 2687)

Conclusions

Training for behavioral skills-building improves AIT technical expertise which is a prerequisite to increase contact elicitation, Tracing, and identification of HIV-positive individuals who are not aware of their HIV status and link them to care and treatment.

Keywords: HIV testing, index case testing, contact tracing, behavioral skills training, Malawi
Suggested citation: Ngambi A, Phiri L, Damiano P, et al. Enhancing Active Index Case Testing: Pre- and Post-Assessment of a Three-Day Behavioral Skills Training for HDAs in MACRO Lilongwe facilities in Malawi. Malawi AIDS Counselling and Resource Organization; 2023.